Description
Career Summary: * Software professional with 15 years of experience in Information Technology. Specialized in development of applications in IBM Mainframe, COBOL/II/370, CICS, VSAM, JCL, Natural, Adabas, MQ Series, XML, Easytrieve, DB2, IMS DB/DC and IBM utilities. Possesses excellent communication and technical skills and strong sense of personal ownership, accountability and commitment. Highmark - NC Jul '08 - Till date OSCAR Claims processing system. Responsibilities: Analyzed design code and unit test change requests for the claims processing CPM & Provider systems. * Excellent ability in analyzing business requirements and translating them into comprehensive system design using Rational requisite Pro. * Worked on change requests and research to enhance OSCAR system to process all lines as received on the incoming claims (999 Lines). * Worked on loading the OPTUM quarterly software updates for Pricing system. Worked on HIPPA 5010 project which replaces the health care transaction standard version 4010. * Worked on HIPPA ICD10 compliance project to implement the necessary changes to recognize the new ICD10 Diagnosis and Procedure code sets Worked on Legacy modernization system to create BD (Blue Devil) components which enhances system to increase system flexibility and maintainability. * Worked on Delaware transitioning project to install the logic changes to process BCBS Delaware Claims on the OSCAR processing platform * Worked on Process Pending database Conversion of PROD claims whenever there are database changes Worked on system defects as part of acceptance testing and also supported the system on post implementation release. * Supported Disaster recovery batch cycle for Highmark. * Worked on an enhancement to validate ITS host Medicare advantage professional and institutional claims to set new suspensions. * Used M4DM to view MVS dumps to work on all system production and Test abends. * Used Rational clearquest for all change requests research and system defects. Experience working on integrated systems environment to copy batch and online claims from one region to other using Highmark DBSave utility. Dumped claims from different regions and load it into other regions used BMP utility to edit and change the claims to process it thru the adjudication cycle. * Querying data from database (SQL) for creating data for unit testing using QMF SPUFI etc. and creating best unit test scenarios covering all aspects of the business requirements * Worked on customer requests to reprocess suspended claims from production through the adjudication batch cycles. * Worked on reconfiguration of the training system to make it ready after the production releases which is used for customer trainings. * Prepared technical design document on how to process suspended claims for the claims processing system to be used by other project members * Committed team player with strong analytical and problem solving skills willingness to quickly adapt to new environments & technologies dedicated to successful project completion and excellent communication and interpersonal skills. Used Endevor as the version control utility for moving the programs to production.
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